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Abstract：
OBJECTIVE: In children with tracheobronchomalacia, surgical management should be reserved for the most severe cases and be specific to the type and location of tracheobronchomalacia. The goal of this study is to describe the presentation and outcomes of children with severe tracheobronchomalacia undergoing surgery.
METHODS: Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement.
RESULTS: The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure.
CONCLUSIONS: Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.
METHODS: Retrospective case series of 20 children operated for severe tracheobronchomalacia at a tertiary hospital from 2003 to 2023. Data were collected on symptoms age at diagnosis, associated comorbidities, previous surgery, age at surgery, operative approach, time of follow-up, and outcome. Surgical success was defined as symptom improvement.
RESULTS: The most frequent symptoms of severe tracheobronchomalacia were stridor (50 %), cyanosis (50 %), and recurrent respiratory infections (45 %). All patients had one or more underlying conditions, most commonly esophageal atresia (40 %) and prematurity (35 %). Bronchoscopy were performed in all patients. Based on etiology, patients underwent the following procedures: anterior aortopexy (n = 15/75 %), posterior tracheopexy (n = 4/20 %), and/or posterior descending aortopexy (n = 4/20 %). Three patients underwent anterior aortopexy and posterior tracheopexy procedures. After a median follow-up of 12 months, 16 patients (80 %) had improvement in respiratory symptoms. Decannulation was achieved in three (37.5 %) out of eight patients with previous tracheotomy. The presence of dying spells at diagnosis was associated with surgical failure.
CONCLUSIONS: Isolated or combined surgical procedures improved respiratory symptoms in 80 % of children with severe tracheobronchomalacia. The choice of procedure should be individualized and guided by etiology: anterior aortopexy for anterior compression, posterior tracheopexy for membranous intrusion, and posterior descending aortopexy for left bronchus obstruction.
摘要：
目标：在患有气管支气管软化症的儿童中，应针对最严重的病例进行手术治疗，并针对气管支气管软化的类型和位置。这项研究的目的是描述患有严重气管支气管软化症的儿童接受手术的表现和结果。
方法：回顾性病例系列，包括2003年至2023年在三级医院接受严重气管支气管软化手术的20名儿童。数据收集了诊断时的症状年龄，相关的合并症，以前的手术，手术年龄，手术入路,随访时间,和结果。手术成功被定义为症状改善。
结果：严重的气管支气管软化症最常见的症状是喘鸣（50％），紫癜（50%），和反复呼吸道感染(45%)。所有患者都有一种或多种潜在疾病，最常见的食管闭锁（40％）和早产（35％）。所有患者均行支气管镜检查。根据病因,患者接受了以下手术：前主动脉固定术（n=15/75％），后气管固定术（n=4/20%），和/或后降主动脉（n=4/20％）。三名患者接受了前主动脉固定术和后气管固定术。经过12个月的中位随访，16例(80%)患者呼吸道症状改善。在8例先前气管切开术的患者中，有3例（37.5％）实现了拔管。诊断时死亡咒语的存在与手术失败有关。
结论：在80％的严重气管支气管软化症患儿中，单独或联合外科手术可改善呼吸道症状。手术的选择应个体化，并以病因为指导：前主动脉固定术用于前压迫，后气管固定术用于膜质侵入，左支气管阻塞后降主动脉固定术。
方法：回顾性病例系列，包括2003年至2023年在三级医院接受严重气管支气管软化手术的20名儿童。数据收集了诊断时的症状年龄，相关的合并症，以前的手术，手术年龄，手术入路,随访时间,和结果。手术成功被定义为症状改善。
结果：严重的气管支气管软化症最常见的症状是喘鸣（50％），紫癜（50%），和反复呼吸道感染(45%)。所有患者都有一种或多种潜在疾病，最常见的食管闭锁（40％）和早产（35％）。所有患者均行支气管镜检查。根据病因,患者接受了以下手术：前主动脉固定术（n=15/75％），后气管固定术（n=4/20%），和/或后降主动脉（n=4/20％）。三名患者接受了前主动脉固定术和后气管固定术。经过12个月的中位随访，16例(80%)患者呼吸道症状改善。在8例先前气管切开术的患者中，有3例（37.5％）实现了拔管。诊断时死亡咒语的存在与手术失败有关。
结论：在80％的严重气管支气管软化症患儿中，单独或联合外科手术可改善呼吸道症状。手术的选择应个体化，并以病因为指导：前主动脉固定术用于前压迫，后气管固定术用于膜质侵入，左支气管阻塞后降主动脉固定术。
